百日咳感染在儿童慢性咳嗽中的地位及其临床特征研究

Prevalence of Bordetella pertussis infection in children with chronic cough and its clinical features

摘要:

目的 调查慢性咳嗽患儿百日咳感染情况及百日咳患儿的临床特征。方法 采集2016年1月1日至2017年5月31日门诊及住院的106例慢性咳嗽患儿的鼻咽拭子、静脉血标本，进行百日咳鲍特菌培养、多重PCR检测及血清抗百日咳毒素抗体检测，根据检测结果分为百日咳组（n=26）和对照组（n=80）。分析比较两组患儿的临床特点；采用E-test法检测分离百日咳鲍特菌菌株对红霉素、阿奇霉素、多西环素、左氧氟沙星、复方新诺明和阿莫西林的敏感性。结果 106例慢性咳嗽患儿中，共26例（24.5%）被检出百日咳阳性。百日咳组与对照组患儿百日咳经典症状发生率比较差异均无统计学意义（P > 0.05）。E-test检测显示红霉素、阿奇霉素对分离的5株百日咳鲍特菌的最小抑菌浓度（MIC）均 > 256 mg/L，阿莫西林的MIC为0.5~1.0 mg/L。结论 临床工作者应重视慢性咳嗽患儿当中百日咳感染的存在，百日咳感染的慢性咳嗽患儿可能不出现百日咳经典症状而只表现为慢性咳嗽。阿莫西林可能成为大环内酯类抗生素耐药菌株感染的备选药物。

Abstract:

Objective To investigate the prevalence of Bordetella pertussis infection in children with chronic cough and its clinical features. Methods A total of 106 children who were treated at the outpatient service or hospitalized from January 1, 2016 to May 31, 2017 were enrolled. Their nasopharyngeal swabs and venous blood samples were collected for Bordetella pertussis culture, multiple PCR and serum anti-pertussis toxin antibody detection. According to these results, the children were divided into pertussis group with 26 children and control group with 80 children, and clinical features were analyzed for both groups. E-test stripes were used to determine the sensitivity of Bordetella pertussis strains to erythromycin, azithromycin, doxycycline, levofloxacin, sulfamethoxazole/trimethoprim and amoxicillin. Results Of the 106 children with chronic cough, 26 (24.5%) were found to have Bordetella pertussis infection. There were no significant differences in the incidence rates of typical symptoms of pertussis between the pertussis and control groups (P > 0.05). E-test showed that erythromycin and azithromycin had a minimal inhibitory concentration (MIC) of > 256 mg/L against five Bordetella pertussis strains, while amoxicillin had an MIC of 0.5-1 mg/L. Conclusions The presence of Bordetella pertussis infection in children with chronic cough should be taken seriously by clinicians, and children with chronic cough and Bordetella pertussis infection may not have the typical symptoms of pertussis and are mainly manifested as chronic cough. Amoxicillin may be an alternative drug for macrolide-resistant Bordetella pertussis infection.